EDI 837 Segments and Elements for the Health Care Claim Standard


AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI837HCHealth Care Claim InsuranceDownload


Online EDI 837 Translation      More about 837s   837 Mapping Specs   Need Help?

Research and Development:
See the list of EDI 837 segments and elements in below data grid. The Jobisez.com site has an online translation tool that converts the EDI 837 (Health Care Claim) document into a CSV file. If you are researching the 837s, you can view other trading partner's mapping specifications. You can also gain knowledge by researching all EDI document types. Jobisez LLC can also provide assistance if you need additional help.

Solutions:
Are you looking to trade the EDI 837 transaction with one of your trading partners? Do you need an EDI VAN Savings solution to exchange the 837? Or perhaps you would like to use a Cloud-Based application, so you can plug your 837 transaction directly into your ERP and TMS systems. Even small companies have the ability to trade the EDI 837 by using the EDI Mobile Device solution.


The EDI 837 Segments and Elements

SegmentDescriptionSectReqMax LoopMax UsagePos
BHTBeginning Of Hierarchical TransactionHM011
REFReference InformationHO032
NM1Individual Or Organizational NameHO1013
N2Additional Name InformationHO024
N3Party LocationHO025
N4Geographic LocationHO016
REFReference InformationHO027
PERAdministrative Communications ContactHO028
HLHierarchical LevelDM99999919
PRVProvider InformationDO0110
SBRSubscriber InformationDO0111
PATPatient InformationDO0112
DTPDate Or Time Or PeriodDO0513
CURCurrencyDO0114
NM1Individual Or Organizational NameDO10115
N2Additional Name InformationDO0216
N3Party LocationDO0217
N4Geographic LocationDO0118
DMGDemographic InformationDO0119
REFReference InformationDO02020
PERAdministrative Communications ContactDO0221
CLMHealth ClaimDO100122
DTPDate Or Time Or PeriodDO015023
CL1Claim CodesDO0124
DN1Orthodontic InformationDO0125
DN2Tooth SummaryDO03526
PWKPaperworkDO01027
CN1Contract InformationDO0128
DSBDisability InformationDO0129
URPeer Review Organization Or Utilization ReviewDO0130
AMTMonetary Amount InformationDO04031
REFReference InformationDO03032
K3File InformationDO01033
NTENote/Special InstructionDO02034
CR1Ambulance CertificationDO0135
CR2Chiropractic CertificationDO0136
CR3Durable Medical Equipment CertificationDO0137
CR4Enteral Or Parenteral Therapy CertificationDO0338
CR5Oxygen Therapy CertificationDO0139
CR6Home Health Care CertificationDO0140
CR8Pacemaker CertificationDO0941
CRCConditions IndicatorDO010042
HIHealth Care Information CodesDO02543
QTYQuantity InformationDO01044
HCPHealth Care PricingDO0145
CR7Home Health Treatment Plan CertificationDO6146
HSDHealth Care Services DeliveryDO01247
NM1Individual Or Organizational NameDO9148
PRVProvider InformationDO0149
N2Additional Name InformationDO0250
N3Party LocationDO0251
N4Geographic LocationDO0152
REFReference InformationDO02053
PERAdministrative Communications ContactDO0254
SBRSubscriber InformationDO10155
CASClaims AdjustmentDO09956
AMTMonetary Amount InformationDO01557
DMGDemographic InformationDO0158
OIOther Health Insurance InformationDO0159
MIAMedicare Inpatient AdjudicationDO0160
MOAMedicare Outpatient AdjudicationDO0161
NM1Individual Or Organizational NameDO10162
N2Additional Name InformationDO0263
N3Party LocationDO0264
N4Geographic LocationDO0165
PERAdministrative Communications ContactDO0266
DTPDate Or Time Or PeriodDO0967
REFReference InformationDO099999968
LXTransaction Set Line NumberDO999999169
SV1Professional ServiceDO0170
SV2Institutional ServiceDO0171
SV3Dental ServiceDO0172
TOOTooth IdentificationDO03273
SV4Drug ServiceDO0174
SV5Durable Medical Equipment ServiceDO0175
SV6Anesthesia ServiceDO0176
SV7Drug AdjudicationDO0177
HIHealth Care Information CodesDO02578
PWKPaperworkDO01079
CR1Ambulance CertificationDO0180
CR2Chiropractic CertificationDO0581
CR3Durable Medical Equipment CertificationDO0182
CR4Enteral Or Parenteral Therapy CertificationDO0383
CR5Oxygen Therapy CertificationDO0184
CRCConditions IndicatorDO0385
DTPDate Or Time Or PeriodDO01586
QTYQuantity InformationDO0587
MEAMeasurementsDO02088
CN1Contract InformationDO0189
REFReference InformationDO03090
AMTMonetary Amount InformationDO01591
K3File InformationDO01092
NTENote/Special InstructionDO01093
PS1Purchase ServiceDO0194
IMMImmunization StatusDO099999995
HSDHealth Care Services DeliveryDO0196
HCPHealth Care PricingDO0197
LINItem IdentificationDO999999198
CTPPricing InformationDO0199
REFReference InformationDO01100
NM1Individual Or Organizational NameDO101101
PRVProvider InformationDO01102
N2Additional Name InformationDO02103
N3Party LocationDO02104
N4Geographic LocationDO01105
REFReference InformationDO020106
PERAdministrative Communications ContactDO02107
SVDService Line AdjudicationDO9999991108
CASClaims AdjustmentDO099109
DTPDate Or Time Or PeriodDO09110
AMTMonetary Amount InformationDO020111
LQIndustry Code IdentificationDO9999991112
FRMSupporting DocumentationDM099113


SegmentElementDescriptionReqMin LengthMax LengthType
BHT1Hierarchical Structure CodeM44ID
BHT2Transaction Set Purpose CodeM22ID
BHT3Reference IdentificationO150AN
BHT4DateO88DT
BHT5TimeO48TM
BHT6Transaction Type CodeO22ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
HL1Hierarchical Id NumberM112AN
HL2Hierarchical Parent Id NumberO112AN
HL3Hierarchical Level CodeM12ID
HL4Hierarchical Child CodeO11ID
PRV1Provider CodeM13ID
PRV2Reference Identification QualifierC23ID
PRV3Reference IdentificationC150AN
PRV4State Or Province CodeO22ID
PRV5Provider Specialty CodeO13AN
PRV6Agency Qualifier CodeO22ID
PRV7Yes/No Condition Or Response CodeO11ID
PRV8Provider Organization CodeO33ID
SBR1Payer Responsibility Sequence Number CodeM11ID
SBR2Individual Relationship CodeO22ID
SBR3Reference IdentificationO150AN
SBR4NameO160AN
SBR5Insurance Type CodeO13ID
SBR6Coordination Of Benefits CodeO11ID
SBR7Yes/No Condition Or Response CodeO11ID
SBR8Employment Status CodeO22ID
SBR9Claim Filing Indicator CodeO12ID
PAT1Individual Relationship CodeO22ID
PAT2Patient Location CodeO11ID
PAT3Employment Status CodeO22ID
PAT4Student Status CodeO11ID
PAT5Date Time Period Format QualifierC23ID
PAT6Date Time PeriodC135AN
PAT7Unit Or Basis For Measurement CodeC22ID
PAT8WeightC110R
PAT9Yes/No Condition Or Response CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
CUR1Entity Identifier CodeM23ID
CUR2Currency CodeM33ID
CUR3Exchange RateO410R
CUR4Entity Identifier CodeO23ID
CUR5Currency CodeO33ID
CUR6Currency Market/Exchange CodeO33ID
CUR7Date/Time QualifierC33ID
CUR8DateO88DT
CUR9TimeO48TM
CUR10Date/Time QualifierC33ID
CUR11DateC88DT
CUR12TimeC48TM
CUR13Date/Time QualifierC33ID
CUR14DateC88DT
CUR15TimeC48TM
CUR16Date/Time QualifierC33ID
CUR17DateC88DT
CUR18TimeC48TM
CUR19Date/Time QualifierC33ID
CUR20DateC88DT
CUR21TimeC48TM
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
CLM1Claim Submitter's IdentifierM138AN
CLM2Monetary AmountO118R
CLM3Claim Filing Indicator CodeO12ID
CLM4Non-Institutional Claim Type CodeO12ID
CLM5Facility Code ValueO12AN
CLM6Facility Code QualifierO12ID
CLM7Claim Frequency Type CodeO11ID
CLM8Yes/No Condition Or Response CodeO11ID
CLM9Provider Accept Assignment CodeO11ID
CLM10Yes/No Condition Or Response CodeO11ID
CLM11Release Of Information CodeO11ID
CLM12Patient Signature Source CodeO11ID
CLM13Related-Causes CodeO23ID
CLM14Related-Causes CodeO23ID
CLM15Related-Causes CodeO23ID
CLM16State Or Province CodeO22ID
CLM17Country CodeO23ID
CLM18Special Program CodeO23ID
CLM19Yes/No Condition Or Response CodeO11ID
CLM20Level Of Service CodeO13ID
CLM21Yes/No Condition Or Response CodeO11ID
CLM22Provider Agreement CodeO11ID
CLM23Claim Status CodeO12ID
CLM24Yes/No Condition Or Response CodeO11ID
CLM25Claim Submission Reason CodeO22ID
CLM26Delay Reason CodeO12ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
CL11Admission Type CodeO11ID
CL12Admission Source CodeO11ID
CL13Patient Status CodeO12ID
CL14Nursing Home Residential Status CodeO11ID
DN11QuantityO115R
DN12QuantityO115R
DN13Yes/No Condition Or Response CodeO11ID
DN14DescriptionO180AN
DN21Reference IdentificationM150AN
DN22Tooth Status CodeO12ID
DN23QuantityO115R
DN24Date Time Period Format QualifierC23ID
DN25Date Time PeriodC135AN
DN26Code List Qualifier CodeM13ID
PWK1Report Type CodeM22ID
PWK2Report Transmission CodeO12ID
PWK3Report Copies NeededO12N0
PWK4Entity Identifier CodeO23ID
PWK5Identification Code QualifierC12ID
PWK6Identification CodeC280AN
PWK7DescriptionO180AN
PWK8Paperwork/Report Action CodeO12ID
PWK9Paperwork/Report Action CodeO12ID
PWK10Paperwork/Report Action CodeO12ID
PWK11Paperwork/Report Action CodeO12ID
PWK12Paperwork/Report Action CodeO12ID
PWK13Request Category CodeO12ID
CN11Contract Type CodeM22ID
CN12Monetary AmountO118R
CN13Percent, Decimal FormatO16R6
CN14Reference IdentificationO150AN
CN15Terms Discount PercentO16R6
CN16Version IdentifierO130AN
DSB1Disability Type CodeM11ID
DSB2QuantityO115R
DSB3Occupation CodeO46ID
DSB4Work Intensity CodeO11ID
DSB5Product Option CodeO12ID
DSB6Monetary AmountO118R
DSB7Product/Service Id QualifierC22ID
DSB8Medical Code ValueC115AN
UR1Approval CodeM11ID
UR2QuantityO115R
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
K31Fixed Format InformationM180AN
K32Record Format CodeO12ID
K33Unit Or Basis For Measurement CodeO22ID
K34ExponentO115R
K35MultiplierO110R
K36Unit Or Basis For Measurement CodeO22ID
K37ExponentO115R
K38MultiplierO110R
K39Unit Or Basis For Measurement CodeO22ID
K310ExponentO115R
K311MultiplierO110R
K312Unit Or Basis For Measurement CodeO22ID
K313ExponentO115R
K314MultiplierO110R
K315Unit Or Basis For Measurement CodeO22ID
K316ExponentO115R
K317MultiplierO110R
NTE1Note Reference CodeO33ID
NTE2DescriptionM180AN
CR11Unit Or Basis For Measurement CodeC22ID
CR12WeightC110R
CR13Ambulance Transport CodeO11ID
CR14Ambulance Transport Reason CodeO11ID
CR15Unit Or Basis For Measurement CodeC22ID
CR16QuantityC115R
CR17Address InformationO155AN
CR18Address InformationO155AN
CR19DescriptionO180AN
CR110DescriptionO180AN
CR21CountC19N0
CR22QuantityC115R
CR23Subluxation Level CodeC23ID
CR24Subluxation Level CodeO23ID
CR25Unit Or Basis For Measurement CodeC22ID
CR26QuantityC115R
CR27QuantityO115R
CR28Nature Of Condition CodeO11ID
CR29Yes/No Condition Or Response CodeO11ID
CR210DescriptionO180AN
CR211DescriptionO180AN
CR212Yes/No Condition Or Response CodeO11ID
CR31Certification Type CodeO11ID
CR32Unit Or Basis For Measurement CodeC22ID
CR33QuantityC115R
CR34Insulin Dependent CodeO11ID
CR35DescriptionO180AN
CR41Yes/No Condition Or Response CodeM11ID
CR42Certification Type CodeO11ID
CR43Unit Or Basis For Measurement CodeC22ID
CR44QuantityC115R
CR45Unit Or Basis For Measurement CodeC22ID
CR46QuantityC115R
CR47Non-Visit CodeO11ID
CR48Unit Or Basis For Measurement CodeC22ID
CR49QuantityC115R
CR410Unit Or Basis For Measurement CodeC22ID
CR411HeightC18R8
CR412Unit Or Basis For Measurement CodeC22ID
CR413WeightC110R
CR414QuantityO115R
CR415DescriptionO180AN
CR416Nutrient Administration Method CodeO11ID
CR417Nutrient Administration Technique CodeO11ID
CR418QuantityO115R
CR419QuantityO115R
CR420DescriptionO180AN
CR421QuantityO115R
CR422Percentage As DecimalO110R
CR423QuantityO115R
CR424QuantityO115R
CR425Percentage As DecimalO110R
CR426QuantityO115R
CR427Percentage As DecimalO110R
CR428QuantityO115R
CR429DescriptionO180AN
CR51Certification Type CodeO11ID
CR52QuantityO115R
CR53Oxygen Equipment Type CodeO11ID
CR54Oxygen Equipment Type CodeO11ID
CR55DescriptionO180AN
CR56QuantityO115R
CR57QuantityO115R
CR58QuantityO115R
CR59DescriptionO180AN
CR510QuantityO115R
CR511QuantityO115R
CR512Oxygen Test Condition CodeO11ID
CR513Oxygen Test Findings CodeO11ID
CR514Oxygen Test Findings CodeO11ID
CR515Oxygen Test Findings CodeO11ID
CR516QuantityO115R
CR517Oxygen Delivery System CodeO11ID
CR518Oxygen Equipment Type CodeO11ID
CR61Prognosis CodeM11ID
CR62DateM88DT
CR63Date Time Period Format QualifierC23ID
CR64Date Time PeriodC135AN
CR65DateO88DT
CR66Yes/No Condition Or Response CodeO11ID
CR67Yes/No Condition Or Response CodeM11ID
CR68Certification Type CodeM11ID
CR69DateC88DT
CR610Product/Service Id QualifierC22ID
CR611Medical Code ValueC115AN
CR612DateO88DT
CR613DateO88DT
CR614DateO88DT
CR615Date Time Period Format QualifierC23ID
CR616Date Time PeriodC135AN
CR617Patient Location CodeC11ID
CR618DateO88DT
CR619DateO88DT
CR620DateO88DT
CR621DateO88DT
CR81Implant Type CodeM11ID
CR82Implant Status CodeM11ID
CR83DateM88DT
CR84DateM88DT
CR85Reference IdentificationM150AN
CR86Reference IdentificationM150AN
CR87Reference IdentificationM150AN
CR88Yes/No Condition Or Response CodeM11ID
CR89Yes/No Condition Or Response CodeM11ID
CRC1Code CategoryM22ID
CRC2Yes/No Condition Or Response CodeM11ID
CRC3Condition IndicatorM23ID
CRC4Condition IndicatorO23ID
CRC5Condition IndicatorO23ID
CRC6Condition IndicatorO23ID
CRC7Condition IndicatorO23ID
HI1Code List Qualifier CodeM13ID
HI2Industry CodeM130AN
HI3Date Time Period Format QualifierM23ID
HI4Date Time PeriodM135AN
HI5Monetary AmountM118R
HI6QuantityM115R
HI7Version IdentifierM130AN
HI8Industry CodeM130AN
HI9Yes/No Condition Or Response CodeM11ID
HI10Code List Qualifier CodeO13ID
HI11Industry CodeO130AN
HI12Date Time Period Format QualifierO23ID
HI13Date Time PeriodO135AN
HI14Monetary AmountO118R
HI15QuantityO115R
HI16Version IdentifierO130AN
HI17Industry CodeO130AN
HI18Yes/No Condition Or Response CodeO11ID
HI19Code List Qualifier CodeO13ID
HI20Industry CodeO130AN
HI21Date Time Period Format QualifierO23ID
HI22Date Time PeriodO135AN
HI23Monetary AmountO118R
HI24QuantityO115R
HI25Version IdentifierO130AN
HI26Industry CodeO130AN
HI27Yes/No Condition Or Response CodeO11ID
HI28Code List Qualifier CodeO13ID
HI29Industry CodeO130AN
HI30Date Time Period Format QualifierO23ID
HI31Date Time PeriodO135AN
HI32Monetary AmountO118R
HI33QuantityO115R
HI34Version IdentifierO130AN
HI35Industry CodeO130AN
HI36Yes/No Condition Or Response CodeO11ID
HI37Code List Qualifier CodeO13ID
HI38Industry CodeO130AN
HI39Date Time Period Format QualifierO23ID
HI40Date Time PeriodO135AN
HI41Monetary AmountO118R
HI42QuantityO115R
HI43Version IdentifierO130AN
HI44Industry CodeO130AN
HI45Yes/No Condition Or Response CodeO11ID
HI46Code List Qualifier CodeO13ID
HI47Industry CodeO130AN
HI48Date Time Period Format QualifierO23ID
HI49Date Time PeriodO135AN
HI50Monetary AmountO118R
HI51QuantityO115R
HI52Version IdentifierO130AN
HI53Industry CodeO130AN
HI54Yes/No Condition Or Response CodeO11ID
HI55Code List Qualifier CodeO13ID
HI56Industry CodeO130AN
HI57Date Time Period Format QualifierO23ID
HI58Date Time PeriodO135AN
HI59Monetary AmountO118R
HI60QuantityO115R
HI61Version IdentifierO130AN
HI62Industry CodeO130AN
HI63Yes/No Condition Or Response CodeO11ID
HI64Code List Qualifier CodeO13ID
HI65Industry CodeO130AN
HI66Date Time Period Format QualifierO23ID
HI67Date Time PeriodO135AN
HI68Monetary AmountO118R
HI69QuantityO115R
HI70Version IdentifierO130AN
HI71Industry CodeO130AN
HI72Yes/No Condition Or Response CodeO11ID
HI73Code List Qualifier CodeO13ID
HI74Industry CodeO130AN
HI75Date Time Period Format QualifierO23ID
HI76Date Time PeriodO135AN
HI77Monetary AmountO118R
HI78QuantityO115R
HI79Version IdentifierO130AN
HI80Industry CodeO130AN
HI81Yes/No Condition Or Response CodeO11ID
HI82Code List Qualifier CodeO13ID
HI83Industry CodeO130AN
HI84Date Time Period Format QualifierO23ID
HI85Date Time PeriodO135AN
HI86Monetary AmountO118R
HI87QuantityO115R
HI88Version IdentifierO130AN
HI89Industry CodeO130AN
HI90Yes/No Condition Or Response CodeO11ID
HI91Code List Qualifier CodeO13ID
HI92Industry CodeO130AN
HI93Date Time Period Format QualifierO23ID
HI94Date Time PeriodO135AN
HI95Monetary AmountO118R
HI96QuantityO115R
HI97Version IdentifierO130AN
HI98Industry CodeO130AN
HI99Yes/No Condition Or Response CodeO11ID
HI100Code List Qualifier CodeO13ID
HI101Industry CodeO130AN
HI102Date Time Period Format QualifierO23ID
HI103Date Time PeriodO135AN
HI104Monetary AmountO118R
HI105QuantityO115R
HI106Version IdentifierO130AN
HI107Industry CodeO130AN
HI108Yes/No Condition Or Response CodeO11ID
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
HCP1Pricing MethodologyC22ID
HCP2Monetary AmountO118R
HCP3Monetary AmountO118R
HCP4Reference IdentificationO150AN
HCP5RateO19R9
HCP6Reference IdentificationO150AN
HCP7Monetary AmountO118R
HCP8Product/Service IdO148AN
HCP9Product/Service Id QualifierC22ID
HCP10Product/Service IdC148AN
HCP11Unit Or Basis For Measurement CodeC22ID
HCP12QuantityC115R
HCP13Reject Reason CodeC22ID
HCP14Policy Compliance CodeO12ID
HCP15Exception CodeO12ID
CR71Discipline Type CodeM22ID
CR72NumberM19N0
CR73NumberM19N0
HSD1Quantity QualifierC22ID
HSD2QuantityC115R
HSD3Unit Or Basis For Measurement CodeO22ID
HSD4Sample Selection ModulusO16R6
HSD5Time Period QualifierC12ID
HSD6Number Of PeriodsO13N0
HSD7Ship/Delivery Or Calendar Pattern CodeO12ID
HSD8Ship/Delivery Pattern Time CodeO11ID
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
PRV1Provider CodeM13ID
PRV2Reference Identification QualifierC23ID
PRV3Reference IdentificationC150AN
PRV4State Or Province CodeO22ID
PRV5Provider Specialty CodeO13AN
PRV6Agency Qualifier CodeO22ID
PRV7Yes/No Condition Or Response CodeO11ID
PRV8Provider Organization CodeO33ID
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
SBR1Payer Responsibility Sequence Number CodeM11ID
SBR2Individual Relationship CodeO22ID
SBR3Reference IdentificationO150AN
SBR4NameO160AN
SBR5Insurance Type CodeO13ID
SBR6Coordination Of Benefits CodeO11ID
SBR7Yes/No Condition Or Response CodeO11ID
SBR8Employment Status CodeO22ID
SBR9Claim Filing Indicator CodeO12ID
CAS1Claim Adjustment Group CodeM12ID
CAS2Claim Adjustment Reason CodeM15ID
CAS3Monetary AmountM118R
CAS4QuantityO115R
CAS5Claim Adjustment Reason CodeC15ID
CAS6Monetary AmountC118R
CAS7QuantityC115R
CAS8Claim Adjustment Reason CodeC15ID
CAS9Monetary AmountC118R
CAS10QuantityC115R
CAS11Claim Adjustment Reason CodeC15ID
CAS12Monetary AmountC118R
CAS13QuantityC115R
CAS14Claim Adjustment Reason CodeC15ID
CAS15Monetary AmountC118R
CAS16QuantityC115R
CAS17Claim Adjustment Reason CodeC15ID
CAS18Monetary AmountC118R
CAS19QuantityC115R
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
OI1Claim Filing Indicator CodeO12ID
OI2Claim Submission Reason CodeO22ID
OI3Yes/No Condition Or Response CodeO11ID
OI4Patient Signature Source CodeO11ID
OI5Provider Agreement CodeO11ID
OI6Release Of Information CodeO11ID
MIA1QuantityM115R
MIA2Monetary AmountO118R
MIA3QuantityO115R
MIA4Monetary AmountO118R
MIA5Reference IdentificationO150AN
MIA6Monetary AmountO118R
MIA7Monetary AmountO118R
MIA8Monetary AmountO118R
MIA9Monetary AmountO118R
MIA10Monetary AmountO118R
MIA11Monetary AmountO118R
MIA12Monetary AmountO118R
MIA13Monetary AmountO118R
MIA14Monetary AmountO118R
MIA15QuantityO115R
MIA16Monetary AmountO118R
MIA17Monetary AmountO118R
MIA18Monetary AmountO118R
MIA19Monetary AmountO118R
MIA20Reference IdentificationO150AN
MIA21Reference IdentificationO150AN
MIA22Reference IdentificationO150AN
MIA23Reference IdentificationO150AN
MIA24Monetary AmountO118R
MOA1Percentage As DecimalO110R
MOA2Monetary AmountO118R
MOA3Reference IdentificationO150AN
MOA4Reference IdentificationO150AN
MOA5Reference IdentificationO150AN
MOA6Reference IdentificationO150AN
MOA7Reference IdentificationO150AN
MOA8Monetary AmountO118R
MOA9Monetary AmountO118R
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
LX1Assigned NumberM16N0
SV11Product/Service Id QualifierM22ID
SV12Product/Service IdM148AN
SV13Procedure ModifierM22AN
SV14Procedure ModifierM22AN
SV15Procedure ModifierM22AN
SV16Procedure ModifierM22AN
SV17DescriptionM180AN
SV18Product/Service IdM148AN
SV19Monetary AmountO118R
SV110Unit Or Basis For Measurement CodeC22ID
SV111QuantityC115R
SV112Facility Code ValueO12AN
SV113Service Type CodeO12ID
SV114Diagnosis Code PointerO12N0
SV115Diagnosis Code PointerO12N0
SV116Diagnosis Code PointerO12N0
SV117Diagnosis Code PointerO12N0
SV118Monetary AmountO118R
SV119Yes/No Condition Or Response CodeO11ID
SV120Multiple Procedure CodeO12ID
SV121Yes/No Condition Or Response CodeO11ID
SV122Yes/No Condition Or Response CodeO11ID
SV123Review CodeO12ID
SV124National Or Local Assigned Review ValueO12AN
SV125Copay Status CodeO11ID
SV126Health Care Professional Shortage Area CodeO11ID
SV127Reference IdentificationO150AN
SV128Postal CodeO315ID
SV129Monetary AmountO118R
SV130Level Of Care CodeO11ID
SV131Provider Agreement CodeO11ID
SV21Product/Service IdC148AN
SV22Product/Service Id QualifierC22ID
SV23Product/Service IdC148AN
SV24Procedure ModifierC22AN
SV25Procedure ModifierC22AN
SV26Procedure ModifierC22AN
SV27Procedure ModifierC22AN
SV28DescriptionC180AN
SV29Product/Service IdC148AN
SV210Monetary AmountO118R
SV211Unit Or Basis For Measurement CodeC22ID
SV212QuantityC115R
SV213Unit RateO110R
SV214Monetary AmountO118R
SV215Yes/No Condition Or Response CodeO11ID
SV216Nursing Home Residential Status CodeO11ID
SV217Level Of Care CodeO11ID
SV31Product/Service Id QualifierM22ID
SV32Product/Service IdM148AN
SV33Procedure ModifierM22AN
SV34Procedure ModifierM22AN
SV35Procedure ModifierM22AN
SV36Procedure ModifierM22AN
SV37DescriptionM180AN
SV38Product/Service IdM148AN
SV39Monetary AmountO118R
SV310Facility Code ValueO12AN
SV311Oral Cavity Designation CodeO13ID
SV312Oral Cavity Designation CodeO13ID
SV313Oral Cavity Designation CodeO13ID
SV314Oral Cavity Designation CodeO13ID
SV315Oral Cavity Designation CodeO13ID
SV316Prosthesis, Crown Or Inlay CodeO11ID
SV317QuantityO115R
SV318DescriptionO180AN
SV319Copay Status CodeO11ID
SV320Provider Agreement CodeO11ID
SV321Yes/No Condition Or Response CodeO11ID
SV322Diagnosis Code PointerO12N0
SV323Diagnosis Code PointerO12N0
SV324Diagnosis Code PointerO12N0
SV325Diagnosis Code PointerO12N0
TOO1Code List Qualifier CodeC13ID
TOO2Industry CodeC130AN
TOO3Tooth Surface CodeO12ID
TOO4Tooth Surface CodeO12ID
TOO5Tooth Surface CodeO12ID
TOO6Tooth Surface CodeO12ID
TOO7Tooth Surface CodeO12ID
SV41Reference IdentificationM150AN
SV42Product/Service Id QualifierO22ID
SV43Product/Service IdO148AN
SV44Procedure ModifierO22AN
SV45Procedure ModifierO22AN
SV46Procedure ModifierO22AN
SV47Procedure ModifierO22AN
SV48DescriptionO180AN
SV49Product/Service IdO148AN
SV410Reference IdentificationO150AN
SV411Yes/No Condition Or Response CodeO11ID
SV412Dispense As Written CodeO11ID
SV413Level Of Service CodeO13ID
SV414Prescription Origin CodeO11ID
SV415DescriptionO180AN
SV416Yes/No Condition Or Response CodeO11ID
SV417Yes/No Condition Or Response CodeO11ID
SV418Unit Dose CodeO11ID
SV419Basis Of Cost Determination CodeO12ID
SV420Basis Of Days Supply Determination CodeO11ID
SV421Dosage Form CodeO22ID
SV422Copay Status CodeO11ID
SV423Patient Location CodeO11ID
SV424Level Of Care CodeO11ID
SV425Prior Authorization Type CodeO11ID
SV51Product/Service Id QualifierM22ID
SV52Product/Service IdM148AN
SV53Procedure ModifierM22AN
SV54Procedure ModifierM22AN
SV55Procedure ModifierM22AN
SV56Procedure ModifierM22AN
SV57DescriptionM180AN
SV58Product/Service IdM148AN
SV59Unit Or Basis For Measurement CodeM22ID
SV510QuantityM115R
SV511Monetary AmountC118R
SV512Monetary AmountC118R
SV513Frequency CodeO11ID
SV514Prognosis CodeO11ID
SV61Product/Service Id QualifierM22ID
SV62Product/Service IdM148AN
SV63Procedure ModifierM22AN
SV64Procedure ModifierM22AN
SV65Procedure ModifierM22AN
SV66Procedure ModifierM22AN
SV67DescriptionM180AN
SV68Product/Service IdM148AN
SV69Facility Code QualifierC12ID
SV610Facility Code ValueC12AN
SV611Monetary AmountO118R
SV612Diagnosis Code PointerO12N0
SV613Diagnosis Code PointerO12N0
SV614Diagnosis Code PointerO12N0
SV615Diagnosis Code PointerO12N0
SV616QuantityO115R
SV617Yes/No Condition Or Response CodeO11ID
SV71Reference IdentificationO150AN
SV72Reference IdentificationO150AN
SV73Prescription Denial Override CodeO22ID
SV74Coverage Level CodeM33ID
SV75Product/Process Characteristic CodeM23ID
SV76Yes/No Condition Or Response CodeO11ID
HI1Code List Qualifier CodeM13ID
HI2Industry CodeM130AN
HI3Date Time Period Format QualifierM23ID
HI4Date Time PeriodM135AN
HI5Monetary AmountM118R
HI6QuantityM115R
HI7Version IdentifierM130AN
HI8Industry CodeM130AN
HI9Yes/No Condition Or Response CodeM11ID
HI10Code List Qualifier CodeO13ID
HI11Industry CodeO130AN
HI12Date Time Period Format QualifierO23ID
HI13Date Time PeriodO135AN
HI14Monetary AmountO118R
HI15QuantityO115R
HI16Version IdentifierO130AN
HI17Industry CodeO130AN
HI18Yes/No Condition Or Response CodeO11ID
HI19Code List Qualifier CodeO13ID
HI20Industry CodeO130AN
HI21Date Time Period Format QualifierO23ID
HI22Date Time PeriodO135AN
HI23Monetary AmountO118R
HI24QuantityO115R
HI25Version IdentifierO130AN
HI26Industry CodeO130AN
HI27Yes/No Condition Or Response CodeO11ID
HI28Code List Qualifier CodeO13ID
HI29Industry CodeO130AN
HI30Date Time Period Format QualifierO23ID
HI31Date Time PeriodO135AN
HI32Monetary AmountO118R
HI33QuantityO115R
HI34Version IdentifierO130AN
HI35Industry CodeO130AN
HI36Yes/No Condition Or Response CodeO11ID
HI37Code List Qualifier CodeO13ID
HI38Industry CodeO130AN
HI39Date Time Period Format QualifierO23ID
HI40Date Time PeriodO135AN
HI41Monetary AmountO118R
HI42QuantityO115R
HI43Version IdentifierO130AN
HI44Industry CodeO130AN
HI45Yes/No Condition Or Response CodeO11ID
HI46Code List Qualifier CodeO13ID
HI47Industry CodeO130AN
HI48Date Time Period Format QualifierO23ID
HI49Date Time PeriodO135AN
HI50Monetary AmountO118R
HI51QuantityO115R
HI52Version IdentifierO130AN
HI53Industry CodeO130AN
HI54Yes/No Condition Or Response CodeO11ID
HI55Code List Qualifier CodeO13ID
HI56Industry CodeO130AN
HI57Date Time Period Format QualifierO23ID
HI58Date Time PeriodO135AN
HI59Monetary AmountO118R
HI60QuantityO115R
HI61Version IdentifierO130AN
HI62Industry CodeO130AN
HI63Yes/No Condition Or Response CodeO11ID
HI64Code List Qualifier CodeO13ID
HI65Industry CodeO130AN
HI66Date Time Period Format QualifierO23ID
HI67Date Time PeriodO135AN
HI68Monetary AmountO118R
HI69QuantityO115R
HI70Version IdentifierO130AN
HI71Industry CodeO130AN
HI72Yes/No Condition Or Response CodeO11ID
HI73Code List Qualifier CodeO13ID
HI74Industry CodeO130AN
HI75Date Time Period Format QualifierO23ID
HI76Date Time PeriodO135AN
HI77Monetary AmountO118R
HI78QuantityO115R
HI79Version IdentifierO130AN
HI80Industry CodeO130AN
HI81Yes/No Condition Or Response CodeO11ID
HI82Code List Qualifier CodeO13ID
HI83Industry CodeO130AN
HI84Date Time Period Format QualifierO23ID
HI85Date Time PeriodO135AN
HI86Monetary AmountO118R
HI87QuantityO115R
HI88Version IdentifierO130AN
HI89Industry CodeO130AN
HI90Yes/No Condition Or Response CodeO11ID
HI91Code List Qualifier CodeO13ID
HI92Industry CodeO130AN
HI93Date Time Period Format QualifierO23ID
HI94Date Time PeriodO135AN
HI95Monetary AmountO118R
HI96QuantityO115R
HI97Version IdentifierO130AN
HI98Industry CodeO130AN
HI99Yes/No Condition Or Response CodeO11ID
HI100Code List Qualifier CodeO13ID
HI101Industry CodeO130AN
HI102Date Time Period Format QualifierO23ID
HI103Date Time PeriodO135AN
HI104Monetary AmountO118R
HI105QuantityO115R
HI106Version IdentifierO130AN
HI107Industry CodeO130AN
HI108Yes/No Condition Or Response CodeO11ID
PWK1Report Type CodeM22ID
PWK2Report Transmission CodeO12ID
PWK3Report Copies NeededO12N0
PWK4Entity Identifier CodeO23ID
PWK5Identification Code QualifierC12ID
PWK6Identification CodeC280AN
PWK7DescriptionO180AN
PWK8Paperwork/Report Action CodeO12ID
PWK9Paperwork/Report Action CodeO12ID
PWK10Paperwork/Report Action CodeO12ID
PWK11Paperwork/Report Action CodeO12ID
PWK12Paperwork/Report Action CodeO12ID
PWK13Request Category CodeO12ID
CR11Unit Or Basis For Measurement CodeC22ID
CR12WeightC110R
CR13Ambulance Transport CodeO11ID
CR14Ambulance Transport Reason CodeO11ID
CR15Unit Or Basis For Measurement CodeC22ID
CR16QuantityC115R
CR17Address InformationO155AN
CR18Address InformationO155AN
CR19DescriptionO180AN
CR110DescriptionO180AN
CR21CountC19N0
CR22QuantityC115R
CR23Subluxation Level CodeC23ID
CR24Subluxation Level CodeO23ID
CR25Unit Or Basis For Measurement CodeC22ID
CR26QuantityC115R
CR27QuantityO115R
CR28Nature Of Condition CodeO11ID
CR29Yes/No Condition Or Response CodeO11ID
CR210DescriptionO180AN
CR211DescriptionO180AN
CR212Yes/No Condition Or Response CodeO11ID
CR31Certification Type CodeO11ID
CR32Unit Or Basis For Measurement CodeC22ID
CR33QuantityC115R
CR34Insulin Dependent CodeO11ID
CR35DescriptionO180AN
CR41Yes/No Condition Or Response CodeM11ID
CR42Certification Type CodeO11ID
CR43Unit Or Basis For Measurement CodeC22ID
CR44QuantityC115R
CR45Unit Or Basis For Measurement CodeC22ID
CR46QuantityC115R
CR47Non-Visit CodeO11ID
CR48Unit Or Basis For Measurement CodeC22ID
CR49QuantityC115R
CR410Unit Or Basis For Measurement CodeC22ID
CR411HeightC18R8
CR412Unit Or Basis For Measurement CodeC22ID
CR413WeightC110R
CR414QuantityO115R
CR415DescriptionO180AN
CR416Nutrient Administration Method CodeO11ID
CR417Nutrient Administration Technique CodeO11ID
CR418QuantityO115R
CR419QuantityO115R
CR420DescriptionO180AN
CR421QuantityO115R
CR422Percentage As DecimalO110R
CR423QuantityO115R
CR424QuantityO115R
CR425Percentage As DecimalO110R
CR426QuantityO115R
CR427Percentage As DecimalO110R
CR428QuantityO115R
CR429DescriptionO180AN
CR51Certification Type CodeO11ID
CR52QuantityO115R
CR53Oxygen Equipment Type CodeO11ID
CR54Oxygen Equipment Type CodeO11ID
CR55DescriptionO180AN
CR56QuantityO115R
CR57QuantityO115R
CR58QuantityO115R
CR59DescriptionO180AN
CR510QuantityO115R
CR511QuantityO115R
CR512Oxygen Test Condition CodeO11ID
CR513Oxygen Test Findings CodeO11ID
CR514Oxygen Test Findings CodeO11ID
CR515Oxygen Test Findings CodeO11ID
CR516QuantityO115R
CR517Oxygen Delivery System CodeO11ID
CR518Oxygen Equipment Type CodeO11ID
CRC1Code CategoryM22ID
CRC2Yes/No Condition Or Response CodeM11ID
CRC3Condition IndicatorM23ID
CRC4Condition IndicatorO23ID
CRC5Condition IndicatorO23ID
CRC6Condition IndicatorO23ID
CRC7Condition IndicatorO23ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
MEA1Measurement Reference Id CodeO22ID
MEA2Measurement QualifierO13ID
MEA3Measurement ValueC120R
MEA4Unit Or Basis For Measurement CodeC22ID
MEA5ExponentC115R
MEA6MultiplierC110R
MEA7Unit Or Basis For Measurement CodeC22ID
MEA8ExponentC115R
MEA9MultiplierC110R
MEA10Unit Or Basis For Measurement CodeC22ID
MEA11ExponentC115R
MEA12MultiplierC110R
MEA13Unit Or Basis For Measurement CodeC22ID
MEA14ExponentC115R
MEA15MultiplierC110R
MEA16Unit Or Basis For Measurement CodeC22ID
MEA17ExponentC115R
MEA18MultiplierC110R
MEA19Range MinimumC120R
MEA20Range MaximumC120R
MEA21Measurement Significance CodeO22ID
MEA22Measurement Attribute CodeC22ID
MEA23Surface/Layer/Position CodeO22ID
MEA24Measurement Method Or DeviceO24ID
MEA25Code List Qualifier CodeC13ID
MEA26Industry CodeC130AN
CN11Contract Type CodeM22ID
CN12Monetary AmountO118R
CN13Percent, Decimal FormatO16R6
CN14Reference IdentificationO150AN
CN15Terms Discount PercentO16R6
CN16Version IdentifierO130AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
K31Fixed Format InformationM180AN
K32Record Format CodeO12ID
K33Unit Or Basis For Measurement CodeO22ID
K34ExponentO115R
K35MultiplierO110R
K36Unit Or Basis For Measurement CodeO22ID
K37ExponentO115R
K38MultiplierO110R
K39Unit Or Basis For Measurement CodeO22ID
K310ExponentO115R
K311MultiplierO110R
K312Unit Or Basis For Measurement CodeO22ID
K313ExponentO115R
K314MultiplierO110R
K315Unit Or Basis For Measurement CodeO22ID
K316ExponentO115R
K317MultiplierO110R
NTE1Note Reference CodeO33ID
NTE2DescriptionM180AN
PS11Reference IdentificationM150AN
PS12Monetary AmountM118R
PS13State Or Province CodeO22ID
IMM1Industry CodeM130AN
IMM2Date Time Period Format QualifierC23ID
IMM3Date Time PeriodC135AN
IMM4Immunization Status CodeC12ID
IMM5Report Type CodeO22ID
IMM6Code List Qualifier CodeM13ID
HSD1Quantity QualifierC22ID
HSD2QuantityC115R
HSD3Unit Or Basis For Measurement CodeO22ID
HSD4Sample Selection ModulusO16R6
HSD5Time Period QualifierC12ID
HSD6Number Of PeriodsO13N0
HSD7Ship/Delivery Or Calendar Pattern CodeO12ID
HSD8Ship/Delivery Pattern Time CodeO11ID
HCP1Pricing MethodologyC22ID
HCP2Monetary AmountO118R
HCP3Monetary AmountO118R
HCP4Reference IdentificationO150AN
HCP5RateO19R9
HCP6Reference IdentificationO150AN
HCP7Monetary AmountO118R
HCP8Product/Service IdO148AN
HCP9Product/Service Id QualifierC22ID
HCP10Product/Service IdC148AN
HCP11Unit Or Basis For Measurement CodeC22ID
HCP12QuantityC115R
HCP13Reject Reason CodeC22ID
HCP14Policy Compliance CodeO12ID
HCP15Exception CodeO12ID
LIN1Assigned IdentificationO120AN
LIN2Product/Service Id QualifierM22ID
LIN3Product/Service IdM148AN
LIN4Product/Service Id QualifierC22ID
LIN5Product/Service IdC148AN
LIN6Product/Service Id QualifierC22ID
LIN7Product/Service IdC148AN
LIN8Product/Service Id QualifierC22ID
LIN9Product/Service IdC148AN
LIN10Product/Service Id QualifierC22ID
LIN11Product/Service IdC148AN
LIN12Product/Service Id QualifierC22ID
LIN13Product/Service IdC148AN
LIN14Product/Service Id QualifierC22ID
LIN15Product/Service IdC148AN
LIN16Product/Service Id QualifierC22ID
LIN17Product/Service IdC148AN
LIN18Product/Service Id QualifierC22ID
LIN19Product/Service IdC148AN
LIN20Product/Service Id QualifierC22ID
LIN21Product/Service IdC148AN
LIN22Product/Service Id QualifierC22ID
LIN23Product/Service IdC148AN
LIN24Product/Service Id QualifierC22ID
LIN25Product/Service IdC148AN
LIN26Product/Service Id QualifierC22ID
LIN27Product/Service IdC148AN
LIN28Product/Service Id QualifierC22ID
LIN29Product/Service IdC148AN
LIN30Product/Service Id QualifierC22ID
LIN31Product/Service IdC148AN
CTP1Class Of Trade CodeO22ID
CTP2Price Identifier CodeC33ID
CTP3Unit PriceC117R
CTP4QuantityC115R
CTP5Unit Or Basis For Measurement CodeC22ID
CTP6ExponentC115R
CTP7MultiplierC110R
CTP8Unit Or Basis For Measurement CodeC22ID
CTP9ExponentC115R
CTP10MultiplierC110R
CTP11Unit Or Basis For Measurement CodeC22ID
CTP12ExponentC115R
CTP13MultiplierC110R
CTP14Unit Or Basis For Measurement CodeC22ID
CTP15ExponentC115R
CTP16MultiplierC110R
CTP17Unit Or Basis For Measurement CodeC22ID
CTP18ExponentC115R
CTP19MultiplierC110R
CTP20Price Multiplier QualifierO33ID
CTP21MultiplierC110R
CTP22Monetary AmountO118R
CTP23Basis Of Unit Price CodeO22ID
CTP24Condition ValueO110AN
CTP25Multiple Price QuantityO12N0
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
PRV1Provider CodeM13ID
PRV2Reference Identification QualifierC23ID
PRV3Reference IdentificationC150AN
PRV4State Or Province CodeO22ID
PRV5Provider Specialty CodeO13AN
PRV6Agency Qualifier CodeO22ID
PRV7Yes/No Condition Or Response CodeO11ID
PRV8Provider Organization CodeO33ID
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
SVD1Identification CodeM280AN
SVD2Monetary AmountM118R
SVD3Product/Service Id QualifierO22ID
SVD4Product/Service IdO148AN
SVD5Procedure ModifierO22AN
SVD6Procedure ModifierO22AN
SVD7Procedure ModifierO22AN
SVD8Procedure ModifierO22AN
SVD9DescriptionO180AN
SVD10Product/Service IdO148AN
SVD11Product/Service IdO148AN
SVD12QuantityO115R
SVD13Assigned NumberO16N0
CAS1Claim Adjustment Group CodeM12ID
CAS2Claim Adjustment Reason CodeM15ID
CAS3Monetary AmountM118R
CAS4QuantityO115R
CAS5Claim Adjustment Reason CodeC15ID
CAS6Monetary AmountC118R
CAS7QuantityC115R
CAS8Claim Adjustment Reason CodeC15ID
CAS9Monetary AmountC118R
CAS10QuantityC115R
CAS11Claim Adjustment Reason CodeC15ID
CAS12Monetary AmountC118R
CAS13QuantityC115R
CAS14Claim Adjustment Reason CodeC15ID
CAS15Monetary AmountC118R
CAS16QuantityC115R
CAS17Claim Adjustment Reason CodeC15ID
CAS18Monetary AmountC118R
CAS19QuantityC115R
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
LQ1Code List Qualifier CodeO13ID
LQ2Industry CodeC130AN
FRM1Assigned IdentificationM120AN
FRM2Yes/No Condition Or Response CodeC11ID
FRM3Reference IdentificationC150AN
FRM4DateC88DT
FRM5Percent, Decimal FormatC16R6


Official Definition:
Data contents of the Health Care Claim Transaction Set (837) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to submit health care claim billing information, encounter information, or both, from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit health care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of health care services within a specific health care/insurance industry segment. For purposes of this standard, providers of health care products or services may include entities such as physicians, hospitals and other medical facilities or suppliers, dentists, and pharmacies, and entities providing medical information to meet regulatory requirements. The payer refers to a third party entity that pays claims or administers the insurance product or benefit or both. For example, a payer may be an insurance company, health maintenance organization (HMO), preferred provider organization (PPO), government agency (Medicare, Medicaid, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), etc.) or an entity such as a third party administrator (TPA) or third party organization (TPO) that may be contracted by one of those groups. A regulatory agency is an entity responsible, by law or rule, for administering and monitoring a statutory benefits program or a specific health care/insurance industry segment.



© Jobisez LLC - Contact Us  About Us  Privacy Statement  Sitemap  Jobisez Blog